Sunday, August 19, 2007

Medicare threatening hospitals

Thanks to MSSP Nexus Blog for pointing out this story. In today's New York Times, there is a story describing a significant policy change directed at hospitals. Of course, this will save Medicare millions of dollars, but what are the unintended consequences of this policy?

Under the new rules, to be published next week, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.” Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder.

In addition, Medicare says it will not pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products. The new policy — one of several federal initiatives to improve care purchased by Medicare, at a cost of more than $400 billion a year — is sending ripples through the health industry.

Now, don't get me wrong. I definitely agree with the intent of this idea. There are definitely some hospital infections that could be prevented, and it's been well documented the impact of medical errors during a hospital stay. I understand why patient advocate groups are happy with this policy decision.

With regard to preventing falls, does that mean that hospitals will have to utilize bed restraints more - because in the middle of the night, sometimes patients are confused and don't know that they're trying to get out of bed. Restraints are already a no-no according to some regulatory agencies.

When it comes to preventing infection, I see more unnecessary testing being done to prove that an infection was obtained before hospitalization. What will be the cost of this? In addition, I see even more increased use of antibiotics, which will further increase the resistance of organisms - and complicating the treatment of infections in the future.

So, while the government's intent is noble, I'm afraid of what the unintended consequences will be. If the government wants people to be accountable, they should start cleaning up their own house first. Of course, we know that will never happen...

16 comments:

Well I gotta tell you, if hospitals were a little more careful maybe people wouldn't get bedsores and c-difficile. I believe that's what killed my mother in the end and currently my best friends father, just hospitalized one week has hospital pneumonia. Is Medicare private or government run? The first tests they do are urine and blood anyway that should eliminate at least the uti infections which can be deadly. Sponges and stuff, yeh make hospitals a little more responsible. Your right, government needs to clean up it's own house but that doesn't preclude cleaning up the other crap, right....ciao

I have to agree that hospitals should probably eat the cost when a sponge is left in at the time of surgery. I'm not convinced, though, that all central line related infections or even all foley-related utis are preventable. Sometimes patients need a central line or a foley, and sometimes those things get infected. It's sort of part of the cost of doing business. Sure, we should minimize their use, and be as sterile as possible with them, but sometimes bad stuff happens.

Rositta - just so you know - there's going to be MORE c diff after the regulations are implemented - because people are going to give antibiotics more to prevent the line infections, and antibiotics can cause c.diff.

I have mixed feelings on this one Doc. If they leave something that shouldn't be there inside a patient during surgery then i don't think Medicare should pay for it.

but, bedsores, even with the best of care can sometimes happen with a patient that is in bed 24/7. Also falls should be indiv. situations. If someone gets up and falls how is that the hospitals fault? If someone has dropped them then thats a different story.

To bad we can't go by the honor system. The only one that really knows whether it was a fall or a drop is the individual.

For cases such as a left behind sponge, I agree with everyone that Medicare should not have to pay for that. Even if the rule is unfair about those questionable events like falls and bedsores, maybe it will translate into better care.

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Oh, wow! I don't know what to say about this. I agree with you that it is a good idea that will end up causing more problems than it solves. And of course, now that the 'spitals are going to be eating more charges that the government used to pay, they are going to recover those costs by ramping up the bills other patients are charged with paying. Sad.

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